隐匿性血气胸患者：机制重要吗？
Occult pneumothoraces in patients with penetrating trauma: Does mechanism matter?
机构信息
Department of Surgery, Grady Memorial Hospital, Emory University, Atlanta, Ga., USA.
出版信息
Can J Surg. 2010 Aug;53(4):251-5.
BACKGROUND
Supine anteroposterior (AP) chest radiography is an insensitive test for detecting posttraumatic pneumothoraces (PTXs). Computed tomography (CT) often identifies occult pneumothoraces (OPTXs) not diagnosed by chest radiography. All previous literature describes the epidemiology of OPTX in patients with blunt polytrauma. Our goal was to identify the frequency of OPTXs in patients with penetrating trauma.
METHODS
All patients with penetrating trauma admitted over a 10-year period to Grady Memorial Hospital with a PTX were identified. We reviewed patients' thoracoabdominal CT scans and corresponding chest radiographs.
RESULTS
Records for 1121 (20%) patients with a PTX (penetrating mechanism) were audited; CT imaging was available for 146 (13%) patients. Of these, 127 (87%) had undergone upright chest radiography. The remainder (19 patients) had a supine AP chest radiograph. Fifteen (79%) of the PTXs detected on supine AP chest radiographs were occult. Only 10 (8%) were occult when an upright chest radiograph was used (p < 0.001). Posttraumatic PTXs were occult on chest radiographs in 17% (25/146) of patients. Fourteen (56%) patients with OPTXs underwent tube thoracostomy, compared with 95% (115/121) of patients with overt PTXs (p < 0.001).
CONCLUSION
Up to 17% of all PTXs in patients injured by penetrating mechanisms will be missed by standard trauma chest radiographs. This increases to nearly 80% with supine AP chest radiographs. Upright chest radiography detects 92% of all PTXs and is available to most patients without spinal trauma. The frequency of tube thoracostomy use in patients with overt PTXs is significantly higher than for OPTXs in blunt and penetrating trauma.
背景
仰卧前后位（AP）胸部 X 线摄影对于检测创伤后气胸（PTX）不敏感。计算机断层扫描（CT）通常可以发现胸部 X 线摄影未诊断出的隐匿性气胸（OPTX）。所有先前的文献都描述了钝性多发伤患者 OPTX 的流行病学。我们的目标是确定穿透性创伤患者中 OPTX 的频率。
方法
我们确定了在 10 年期间因 PTX 而被 Grady Memorial 医院收治的所有穿透性创伤患者。我们回顾了患者的胸腹部 CT 扫描和相应的胸部 X 光片。
结果
共审核了 1121 例（20%）因穿透性机制导致 PTX 的患者记录；146 例（13%）患者可进行 CT 成像。其中，127 例（87%）进行了直立胸部 X 光检查。其余（19 例）接受了仰卧 AP 胸部 X 光检查。仰卧 AP 胸部 X 光检查发现的 15 例（79%）PTX 为隐匿性。仅当使用直立胸部 X 光检查时，才有 10 例（8%）为隐匿性（p<0.001）。在 146 例患者中，17%（25/146）的创伤性 PTX 在胸部 X 光片上为隐匿性。与明显的 PTX 患者（115/121，95%）相比，有 14 例（56%）隐匿性 OPTX 患者接受了胸腔引流管治疗（p<0.001）。
结论
穿透性机制导致的所有 PTX 中，多达 17%会被标准创伤性胸部 X 光检查遗漏。如果使用仰卧 AP 胸部 X 光检查，这一比例将增加到近 80%。直立胸部 X 光检查可检测到所有 PTX 的 92%，且大多数无脊柱创伤的患者都可进行该检查。明显的 PTX 患者使用胸腔引流管的频率明显高于钝性和穿透性创伤患者的 OPTX。
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